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Inpatient vs outpatient management of pregnancies with vasa previa: A historical cohort study
INTRODUCTION: Vasa previa, a condition where unprotected fetal blood vessels lie in proximity to the internal cervical opening, is a potentially lethal obstetric complication. The precarious situation of these vessels increases the risk of fetal hemorrhage with spontaneous or artificial rupture of m...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10577631/ https://www.ncbi.nlm.nih.gov/pubmed/37537788 http://dx.doi.org/10.1111/aogs.14595 |
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author | Villani, Linda A. Al‐Torshi, Rashida Shah, Prakesh S. Kingdom, John C. D'Souza, Rohan Keunen, Johannes |
author_facet | Villani, Linda A. Al‐Torshi, Rashida Shah, Prakesh S. Kingdom, John C. D'Souza, Rohan Keunen, Johannes |
author_sort | Villani, Linda A. |
collection | PubMed |
description | INTRODUCTION: Vasa previa, a condition where unprotected fetal blood vessels lie in proximity to the internal cervical opening, is a potentially lethal obstetric complication. The precarious situation of these vessels increases the risk of fetal hemorrhage with spontaneous or artificial rupture of membranes, frequently causing fetal/neonatal demise or severe morbidity. As a result, in many centers, inpatient management forms the mainstay when vasa previa is diagnosed antenatally. This study aimed to determine whether a subpopulation of pregnancies diagnosed antenatally with vasa previa could be safely managed as outpatients. MATERIAL AND METHODS: We reviewed all cases of vasa previa in singleton pregnancies, with no fetal anomalies, diagnosed at Mount Sinai Hospital, Toronto, from January 2008 to December 2017. Cases were categorized into three arms for analysis: outpatients (OP), asymptomatic hospitalized (ASH) and symptomatic hospitalized (SH). The SH arm included patients admitted with any antepartum bleeding or suspicious fetal non‐stress test. Those that presented with symptomatic uterine activity/threatened preterm labor and delivered within 7 days of diagnosis were excluded from the study. Records were analyzed for details on hospitalization, antenatal corticosteroid administration, cervical length measurements, and fetal/neonatal mortality and morbidity. RESULTS: Of the 84 antenatally‐diagnosed cases of vasa previa, 47 fulfilled eligibility criteria. A total of 15 cases were managed as OP, 22 as ASH and 10 as SH. Unplanned cesareans were highest in the SH arm (40% vs. 0% ASH vs. 13.3% OP). Those in the SH arm delivered earliest (median 33.8 weeks, interquartile range (IQR) 33.2–34.3 weeks). Of the asymptomatic patients, those in the ASH arm delivered earlier than those in the OP arm (35.3 [34.6–36.2] weeks vs. 36.7 [35.6–37.2] weeks, p = 0.037). There were no cases of fetal/neonatal death, anemia or severe neonatal morbidity and no significant differences between groups based on cervical length or antenatal corticosteroid administration. CONCLUSIONS: Our study suggests that asymptomatic women with an antenatal diagnosis of vasa previa, singleton pregnancies, and at low risk for preterm birth may safely managed as outpatients, as long as they are able to access hospital promptly in the event of antepartum bleeding or early labor. |
format | Online Article Text |
id | pubmed-10577631 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-105776312023-10-17 Inpatient vs outpatient management of pregnancies with vasa previa: A historical cohort study Villani, Linda A. Al‐Torshi, Rashida Shah, Prakesh S. Kingdom, John C. D'Souza, Rohan Keunen, Johannes Acta Obstet Gynecol Scand Pregnancy INTRODUCTION: Vasa previa, a condition where unprotected fetal blood vessels lie in proximity to the internal cervical opening, is a potentially lethal obstetric complication. The precarious situation of these vessels increases the risk of fetal hemorrhage with spontaneous or artificial rupture of membranes, frequently causing fetal/neonatal demise or severe morbidity. As a result, in many centers, inpatient management forms the mainstay when vasa previa is diagnosed antenatally. This study aimed to determine whether a subpopulation of pregnancies diagnosed antenatally with vasa previa could be safely managed as outpatients. MATERIAL AND METHODS: We reviewed all cases of vasa previa in singleton pregnancies, with no fetal anomalies, diagnosed at Mount Sinai Hospital, Toronto, from January 2008 to December 2017. Cases were categorized into three arms for analysis: outpatients (OP), asymptomatic hospitalized (ASH) and symptomatic hospitalized (SH). The SH arm included patients admitted with any antepartum bleeding or suspicious fetal non‐stress test. Those that presented with symptomatic uterine activity/threatened preterm labor and delivered within 7 days of diagnosis were excluded from the study. Records were analyzed for details on hospitalization, antenatal corticosteroid administration, cervical length measurements, and fetal/neonatal mortality and morbidity. RESULTS: Of the 84 antenatally‐diagnosed cases of vasa previa, 47 fulfilled eligibility criteria. A total of 15 cases were managed as OP, 22 as ASH and 10 as SH. Unplanned cesareans were highest in the SH arm (40% vs. 0% ASH vs. 13.3% OP). Those in the SH arm delivered earliest (median 33.8 weeks, interquartile range (IQR) 33.2–34.3 weeks). Of the asymptomatic patients, those in the ASH arm delivered earlier than those in the OP arm (35.3 [34.6–36.2] weeks vs. 36.7 [35.6–37.2] weeks, p = 0.037). There were no cases of fetal/neonatal death, anemia or severe neonatal morbidity and no significant differences between groups based on cervical length or antenatal corticosteroid administration. CONCLUSIONS: Our study suggests that asymptomatic women with an antenatal diagnosis of vasa previa, singleton pregnancies, and at low risk for preterm birth may safely managed as outpatients, as long as they are able to access hospital promptly in the event of antepartum bleeding or early labor. John Wiley and Sons Inc. 2023-08-03 /pmc/articles/PMC10577631/ /pubmed/37537788 http://dx.doi.org/10.1111/aogs.14595 Text en © 2023 The Authors. Acta Obstetricia et Gynecologica Scandinavica published by John Wiley & Sons Ltd on behalf of Nordic Federation of Societies of Obstetrics and Gynecology (NFOG). https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Pregnancy Villani, Linda A. Al‐Torshi, Rashida Shah, Prakesh S. Kingdom, John C. D'Souza, Rohan Keunen, Johannes Inpatient vs outpatient management of pregnancies with vasa previa: A historical cohort study |
title | Inpatient vs outpatient management of pregnancies with vasa previa: A historical cohort study |
title_full | Inpatient vs outpatient management of pregnancies with vasa previa: A historical cohort study |
title_fullStr | Inpatient vs outpatient management of pregnancies with vasa previa: A historical cohort study |
title_full_unstemmed | Inpatient vs outpatient management of pregnancies with vasa previa: A historical cohort study |
title_short | Inpatient vs outpatient management of pregnancies with vasa previa: A historical cohort study |
title_sort | inpatient vs outpatient management of pregnancies with vasa previa: a historical cohort study |
topic | Pregnancy |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10577631/ https://www.ncbi.nlm.nih.gov/pubmed/37537788 http://dx.doi.org/10.1111/aogs.14595 |
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